Laryngeal polyps: symptoms and treatment

Laryngeal polyps are benign growths that form on the surface of the vocal folds (less commonly, in other areas of the larynx) and protrude into the lumen, disrupting vibration and closure of the folds. Essentially, they are localized "bulges" of soft tissue, most often from the superficial layer of the vocal fold (the so-called Reinke's space), filled with edematous tissue or saturated with blood. This causes the voice to become hoarse, "damaged," fatigue quickly, and narrow its range. Unlike vocal fold nodules, polyps are usually unilateral and larger. [1]

The main cause is repeated microtrauma to the tissue during vocal strain: loud speech, shouting, and long, uninterrupted performances. Additional "amplifiers" include smoking and laryngopharyngeal reflux: tobacco smoke and the acidic contents of the stomach irritate the mucous membrane and worsen swelling. Finally, "bloody" (hemorrhagic) polyps are characterized by the rupture of small vessels, which soaks the tissue with blood—therefore, they are more common in adult men, who often experience higher vocal strain and pressure in the larynx. [2]

A polyp is a benign condition; it does not develop into cancer. However, chronic hoarseness affects work and quality of life: speech, singing, communication, and emotions. The longer a person struggles with symptoms, the higher the risk of compensatory voice production habits, which can perpetuate dysphonia even after polyp removal. Therefore, a modern approach always includes voice therapy, risk factor management, and, when indicated, gentle surgery. [3]

A strength of the 2020s is combined rehabilitation. Voice therapy, surgery (microlaryngoscopy with microincision), and their combination have been reliably shown to improve vocal performance. In terms of overall effectiveness for obvious polyps, surgical tactics and the combination of "surgery plus therapy" are superior to therapy alone. The choice of strategy is individualized, taking into account the size and type of polyp, occupation, timing, and associated factors. [4]

Code according to ICD-10 and ICD-11

The International Classification of Diseases, 10th revision, provides a separate code for vocal fold and laryngeal polyps, J38.1 "Polyp of vocal fold and larynx." This code conveniently covers both the "classic" vocal fold polyp and rare polyps of other parts of the larynx. For associated nodules, the adjacent code, J38.2 "Vocal fold nodules," is used. [5]

The International Classification of Diseases, 11th revision, uses the category CA0H.1 "Polyp of vocal fold or larynx." The CA0H section of the ICD-11 groups disorders of the vocal folds and larynx and allows for further refinement of the condition through post-coordination (e.g., secondary factors). This facilitates accurate coding and data exchange between specialists. [6]

Table 1. ICD codes for laryngeal polyps

Situation	ICD-10 code	How to record	ICD-11 code
Vocal fold/larynx polyp	J38.1	Vocal fold polyp (larynx)	CA0H.1
Vocal fold nodules (for differentiation)	J38.2	Vocal fold nodules	CA0H.2
Other diseases of the vocal folds/larynx	J38.7	In concomitant conditions	CA0H.Y
[7]

Epidemiology

Precise "population" percentages for polyps are scarce: most data are from clinical series. In adults, polyps are one of the most common causes of persistent hoarseness among benign vocal fold lesions. In samples from phoniatric clinics, polyps and nodules constitute a significant proportion of all patients with dysphonia; hemorrhagic polyps are more common in middle-aged men. [8]

Reviews describe a predominance of unilateral polyps located on the free edge of the vocal fold in the anterior or middle third, where the amplitude of vibrations is greatest and, therefore, microtrauma is likely. Polyps are diagnosed more frequently in voice professionals (teachers, announcers, singers, call center trainers) than in the general population, reflecting the impact of chronic vocal strain. [9]

The incidence in childhood is low, but polyps in adolescents/young singers are common due to overuse and mutational changes. In older adults, large, edematous (gelatinous) polyps and associated edema of the Reinke's space are more common, especially with smoking. [10]

Table 2. Epidemiological guidelines (indicative)

Parameter	Trend
Floor	Hemorrhagic polyps are more common in men; gelatinous polyps are without obvious distortion.
Age	Peak age: 30-60 years; in the elderly, there is often a large edematous component
Localization	The free edge of the vocal fold, usually unilateral
Risky professions	Teachers, singers, announcers, salespeople, call center employees
[11]

Reasons

The primary mechanism is "phonotrauma": repeated microscopic impacts of the edges of the vocal folds against each other during loud or prolonged speaking/singing. In the zone of maximum tension and shear (anterior-middle third), capillaries and the connective tissue "matrix" are damaged, triggering swelling and a localized protrusion—a polyp. [12]

A hemorrhagic polyp occurs when superficial vessels rupture, resulting in bleeding into the superficial layer of the mucosa (Reinke's space). This type of polyp often appears acutely after an episode of loud screaming or a coughing illness and persists for months. [13]

Gelatinous (edematous) polyps develop gradually: prolonged stress, smoking, and reflux maintain chronic irritation, intercellular fluid accumulates in the tissue, and matrix components (including hyaluronic acid) are altered. The result is a soft, translucent formation. [14]

Risk factors

Smoking is one of the most powerful factors: smoke dries and irritates the mucous membrane, increases capillary fragility, and maintains swelling. Edema of the Reinke's space, often associated with polyps in smokers, itself impairs vibration and makes the voice low and hoarse. [15]

Laryngopharyngeal reflux increases the acid load on the larynx and is associated with chronic mucosal edema; its control reduces the risk of recurrence. Those at risk include those forced to speak loudly in noisy environments, without a microphone, and those who have already suffered "vocal trauma." [16]

Brief but intense overloads ("lost your voice overnight") are also dangerous: a single "storm" can lead to vascular rupture and hemorrhagic polyps. Anatomical factors also play a role—for example, thin epithelium and "dry" mucous membranes due to dehydration. [17]

Pathogenesis

The polyp develops in the superficial layer of the mucous membrane—the thin, elastic layer responsible for the free vibrations of the vocal fold. Microtrauma disrupts the micro-connections of the matrix, causing swelling and localized deformation of the surface. This disrupts the symmetry and phase of the vibrations, resulting in incomplete closure of the folds. [18]

In the hemorrhagic variant, blood extravasation and subsequent tissue remodeling play a key role; in the gelatinous variant, chronic matrix hydration and epithelial hyperplasia at the apex of the polyp play a key role. The overall consequence is the same: the oscillatory mode of the voice becomes unstable, resulting in "double" sound, broken notes, and a decrease in endurance. [19]

Symptoms

The leading symptom is hoarseness (dysphonia): the voice becomes hoarse, loses pitch and clarity, and tires quickly. Frequent airy bleeps and the need to cough more frequently occur. Symptoms last from weeks to months; with hemorrhagic polyps, the onset is often acute, "after screaming." [20]

Singers and speakers typically complain of a lowered upper register, broken notes, a grainy timbre, and an inability to perform a long set. Large polyps can cause a foreign body sensation, a rare cough, and shortness of breath. Pain is usually absent. [21]

Table 3. "Common" complaints and "red flags"

Symptom	What does it mean	Action
Hoarseness >3-4 weeks	Suspected vocal fold damage	Examination by an ENT doctor with stroboscopy
Breakdown of high notes, rapid fatigue	Vibration disorder of the folds (polyp/nodule)	Voice therapy ± surgery as indicated
Sudden hoarseness "after screaming"	Possible hemorrhagic polyp	Urgent examination, gentle voice
Pain, hemoptysis, progressive weight loss	Atypical for a polyp, exclude other causes	Emergency diagnostics
[22]

Classification, forms and "stages"

Clinically, there are two main types: hemorrhagic (reddish, dense, "heavy") and gelatinous (translucent, "watery") polyps. By shape, they are pedunculated (on a thin "stalk") and sessile (with a wide base). The polyp is almost always solitary and unilateral. [23]

There is no specific oncological "staging," but in practice, a distinction is made between small asymptomatic polyps, symptomatic polyps, and large polyps that interfere with closure and vibration. This determines the choice of strategy: observation and therapy, office-based techniques, or surgical microlaryngoscopy. [24]

Table 4. Working classification of vocal fold polyps

Sign	Options	Clinical significance
Compound	Hemorrhagic/gelatinous	Affects mass and "heaviness"
Base	Leg / wide	Determines the removal technique
Size	Small / Medium / Large	Sets the treatment priority
Lateralization	Mostly one-sided	Helps to distinguish from nodules
[25]

Complications and consequences

The main problem is persistent dysphonia, limiting professional activity and quality of life (the Voice Handicap Index questionnaire reflects this particularly well). With prolonged exposure, abnormal vocal habits develop, requiring longer rehabilitation even after polyp removal. [26]

Secondary complications are rare but possible: hemorrhage into the polyp "after crying," contact injuries to the opposite fold ("reactive" edema/nodule), chronic coughing. The polyp usually does not cause life-threatening conditions. [27]

When to see a doctor

If hoarseness persists for more than 3-4 weeks, it's time to see an ENT specialist with stroboscopy. Singers, teachers, and other professional voices shouldn't wait: early voice therapy and proper training can often avoid surgery. [28]

If the voice suddenly "breaks" after screaming, especially if it persists for several days, an examination is also necessary: it could be a hemorrhagic polyp or submucosal hemorrhage. If pain, hemoptysis, or weight loss are present, the examination should be expedited to rule out other causes of hoarseness. [29]

Diagnostics

Step 1: Flexible videolaryngoscopy and videostroboscopy. The doctor views the polyp and evaluates its size, base, color, and its effect on closure and oscillation symmetry. Stroboscopy shows how much the oscillation wave "breaks," which helps determine the appropriate course of action. [30]

Step 2: Acoustic and perceptual voice assessment. Range, maximum phonation time, and pitch fluctuation are measured; the patient completes the Voice Handicap Index questionnaire, which accurately reflects the impact of the problem on life and serves as a "starting point" for treatment. [31]

Step 3: Risk factor assessment. Discuss voice pattern, working conditions (noise, microphone), smoking, and the main symptoms of reflux. This is important because without correcting the "background" factors, the polyp may return, and the voice may not fully recover. [32]

Step 4 - Visualization as indicated. Computed tomography/magnetic resonance imaging are rarely required, only if the findings are atypical or another disease is suspected. A biopsy is generally unnecessary, as the polyp has a characteristic appearance; tissue is examined if there are atypical areas. [33]

Table 5. Diagnostic route if a polyp is suspected

Stage	What does it give?	When needed
Videolaryngostroboscopy	Confirms polyp, evaluates vibration	Always
Acoustics + Voice Handicap Index	Voice "numbers" and their impact on life	Before and after treatment
Reflux screening, load assessment	Search for risk factors	Always
CT/MRI, biopsy	Exclusion of atypical processes	According to the readings
[34]

Differential diagnosis

The most common "double" lesions are vocal fold nodules (usually bilateral "mirror" thickenings), vocal fold cysts (intra-tissue cavities, often "hard" on stroboscopy), and Reinke's space edema (polypoid swelling throughout the entire fold, more common in smokers). Polyps are typically solitary, one-sided, and protrude clearly into the lumen. [35]

Less frequently, it is necessary to differentiate from papillomatosis, posterior commissure granulomas (more common with reflux), and early neoplasms. When in doubt, an experienced examination, stroboscopy, and, if necessary, targeted removal of the lesion with histological examination are decisive. [36]

Treatment

The first pillar is voice therapy. A speech therapist/phoniatrist teaches economical techniques: how to reduce the impact load on the folds, regulate breathing, work with the microphone, "warm up" the voice, and rest. Within just 4-8 weeks of training, "rigid" habits and compensatory strains are reduced, and the voice becomes clearer even before surgery. For small polyps in non-professional voices, one therapy may be sufficient. [37]

The second pillar is risk factor management. Smoking cessation dramatically improves outcomes and reduces the risk of relapse. Reflux management (diet, behavioral interventions, medications) reduces swelling and improves post-operative comfort. Workspace organization (microphone, breaks, air humidification) are simple but critical elements. [38]

The third tool is in-office techniques. For selected small polyps, in-office photocoagulation of blood vessels (dye lasers or potassium-titanyl-phosphate lasers) is possible through a flexible endoscope: the doctor "turns off" the feeding vessels, and the polyp "shrinks" or shrinks. Advantages: no anesthesia and quick; limitations: not every polyp is suitable, and precise technique is required. [39]

The gold standard for severe and persistent polyps is microlaryngoscopy under general anesthesia. Using a microscope, the physician makes a micro-incision (a micro-"flap") on the superior surface of the fold, "exfoliates" the polyp's contents, sparing the vibrating layer, and carefully places the mucous flap back into place. This "phonosurgery" restores symmetry and closure with minimal trauma. [40]

Which is better: "therapy first" or "surgery immediately"? A modern meta-analysis has shown that all three approaches (therapy alone, surgery alone, and a combination) are effective, but the greatest voice improvement is often achieved after surgery, and especially after the combination of "surgery plus voice therapy." Therefore, for voice professionals and for obvious polyps, the doctor often recommends the combined approach. [41]

After surgery, it's important to allow the tissue to heal properly. Typically, 3-7 days of relative vocal rest (no whispering) are prescribed, followed by a gradual return to speech with light phonation exercises. Humidity, fluid intake, limiting caffeine and alcohol, and protection from respiratory infections are simple steps that can really speed up recovery. [42]

Alternative techniques include laser microsurgery. The use of lasers (e.g., carbon dioxide and potassium titanium phosphate) allows for highly precise treatment of vascular polyps and minimizes bleeding. The choice of instrument depends on the type of polyp and the surgeon's preferences; the final decision is made not by the "laser" but by the gentle technique and subsequent rehabilitation. [43]

Injection techniques are used to a limited extent. Intrapolyp steroid injection can reduce swelling of small gelatinous polyps in some patients, but evidence of long-term benefit is limited; this method is suitable as a "bridge" to primary treatment or when surgery is undesirable. The decision is made on an individual basis after stroboscopy. [44]

When can I expect results? According to observational studies, a noticeable reduction in "vocal damage" (as measured by the Voice Handicap Index) is often visible within 1-3 months after microincision; the voice then "matures" for another 2-3 months with therapy. It is important to continue voice lessons with a speech therapist—they "reinforce" the correct voice and protect against re-injury. [45]

And finally, a tactic for voice professionals. Here, the plan is more comprehensive: preoperative lessons in economical phonation, surgery during the "quiet" period, early gentle phonation, and a gradual return to rehearsals with stroboscopy monitoring. This "gradual approach" reduces the risk of relapse and also helps psychologically—the person understands clear timelines and criteria for return. [46]

Table 6. Comparison of the main treatment options

Scenario	What are we doing?	Strengths	Restrictions
Small polyp, unprofessional voice	Voice therapy, factor control	Without surgery, it forms correct skills	The effect is not always sufficient
Small "vascular" polyp	Office photocoagulation (flexible endoscope)	Without anesthesia, quickly	Not suitable for everyone, experience required
Pronounced polyp, prof. voice	Microlaryngoscopy + voice therapy	The greatest and most stable voice effect	Anesthesia, short-term recovery
Any polyp + smoking/reflux	Smoking cessation, reflux control	Reduces recurrence, improves healing	Requires discipline
[47]

Prevention

The most effective approach is prevention of phonotrauma: using a microphone instead of shouting, taking "vocal breaks," economical phonation techniques, humidifying the air, and drinking enough fluids. For singers and speakers, regular sessions with a phoniatrist are as much "fitness" for the voice as training is for muscles. [48]

Quitting smoking and controlling reflux reduce the risk of new polyps and speed recovery. During respiratory infections, it's important to reduce the strain on the voice and avoid prolonged coughing, which also causes microtrauma. [49]

Forecast

The prognosis for vocal fold polyps is excellent. In most cases, a clear, stable voice can be restored; in professionals, it allows a return to the stage/auditorium. A combination of gentle phonosurgery and voice therapy offers the best chance of lasting results. [50]

The risk of recurrence is low if recommendations are followed, but increases if smoking and previous vocal strain persist. The recurrence of a polyp is a signal to reconsider habits and "retrain" the voice. [51]

FAQ

Could it be cancer?
A polyp is a benign growth. But any hoarseness lasting longer than 3-4 weeks requires an examination and stroboscopy to rule out other causes. [52]

Is it possible to "resolve" a polyp without surgery?
Sometimes, yes, for small and "soft" polyps, performed by non-professionals. But for more severe polyps, the best results are often achieved with surgery combined with voice therapy. [53]

How long does it take to recover from microsurgery?
Typically, it takes 1-2 weeks to reach everyday speech and 4-8 weeks to reach a "working" voice with lessons from a phoniatrist. Improvement on the Voice Handicap Index questionnaire is often noticeable within 1-3 months. [54]

Is in-office laser treatment better?
It's convenient and suitable for small vascular polyps. For larger and "hard" polyps, microlaryngoscopy remains the standard. The doctor makes the choice after stroboscopy. [55]

Will the polyp return if I lose my voice again?
There is a risk. Therefore, after treatment, it's important to practice economical phonation techniques, take breaks, and quit smoking—this is the best insurance against recurrence. [56]